Physician-assisted deaths under the euthanasia law in Belgium: a population-based survey
By Kenneth Chambaere, PhD, Johan Bilsen, RN PhD, Joachim Cohen, PhD, Bregje D. Onwuteaka-Philipsen, PhD, Freddy Mortier, PhD, Luc Deliens, PhD
Canadian Medical Association Journal June 15, 2010 vol. 182 no. 9
Author Affiliations
1. From the End-of-Life Care Research Group (Chambaere, Bilsen, Cohen, Deliens) and the Department of Public Health (Bilsen), Vrije Universiteit Brussel, Brussels, Belgium; the Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Expertise Center for Palliative Care (Onwuteaka-Philipsen, Deliens), VU University Medical Centre, Amsterdam, the Netherlands; and the Bioethics Institute Ghent (Mortier), Ghent University, Ghent, Belgium
Abstract
Background:
Legalization of euthanasia and physician-assisted suicide has been heavily debated in many countries. To help inform this debate, we describe the practices of euthanasia and assisted suicide, and the use of life-ending drugs without an explicit request from the patient, in Flanders, Belgium, where euthanasia is legal.
Methods:
We mailed a questionnaire regarding the use of life-ending drugs with or without explicit patient request to physicians who certified a representative sample (n = 6927) of death certificates of patients who died in Flanders between June and November 2007.
Results:
The response rate was 58.4%. Overall, 208 deaths involving the use of life-ending drugs were reported: 142 (weighted prevalence 2.0%) were with an explicit patient request (euthanasia or assisted suicide) and 66 (weighted prevalence 1.8%) were without an explicit request. Euthanasia and assisted suicide mostly involved patients less than 80 years of age, those with cancer and those dying at home. Use of life-ending drugs without an explicit request mostly involved patients 80 years of older, those with a disease other than cancer and those in hospital. Of the deaths without an explicit request, the decision was not discussed with the patient in 77.9% of cases. Compared with assisted deaths with the patient’s explicit request, those without an explicit request were more likely to have a shorter length of treatment of the terminal illness, to have cure as a goal of treatment in the last week, to have a shorter estimated time by which life was shortened and to involve the administration of opioids.
Interpretation:
Physician-assisted deaths with an explicit patient request (euthanasia and assisted suicide) and without an explicit request occurred in different patient groups and under different circumstances. Cases without an explicit request often involved patients whose diseases had unpredictable end-of-life trajectories. Although opioids were used in most of these cases, misconceptions seem to persist about their actual life-shortening effects.
